Thursday, January 1, 2009

Joseph Delboeuf and the History of Psychological Healing

During the late twentieth century a number of controversies erupted in the United States over such questions as the genuineness of multiple personality phenomena and the recovery of lost memories of sexual abuse. On one side psychotherapists insisted that the phenomena in question were genuine and that they had been overlooked because of bias and ignorance. On the other side critics argued that overly zealous therapists were unwittingly suggesting the phenomena to their patients and thereby creating unnecessary morbidity. What characterizes these episodes is the polarization that develops between those who have seen the phenomenon and those who have not. It is an embarrassing polarization, seemingly more appropriate to religious disputes of earlier centuries than to twentieth century medical science. While these controversies died down, it is apparently only because the adversaries have withdrawn from combat. As periodic eruptions show, however, both sides still cling to their polarized views of the essential truths in these important clinical issues.

For the historian, what is striking is how frequently such controversies seem to recur. From the royal commission investigating Mesmer's claims, to the debates over somnambulism and spiritualism, through the debate between Charcot and Bernheim over hypnosis, and to the various schools of psychoanalysis the same question has reemerged. Insight into the social-psychology of these controversies has not been lacking, though it seems as if it must be rediscovered with each new eruption of controversy. In 1886 the Belgian philosopher Joseph Delboeuf boldly proposed a social-psychological and historical explanation of the polarizing controversy he was witnessing, that has resonance through the twentieth century to the controversies we have recently been experiencing. "Doubtless there is an action of the hypnotist on the hypnotized--like master, like disciple" he argued in a manner that many would agree with, then and now. Delboeuf, however, went further insisting that, "... the subjects themselves, primarily the first , shape… the person who molds them and, without his knowledge, dictate his method and tactics to him. In this way, turning the proverb upside down, we can say : like subject, like master' [Delboeuf, August 1886, 149]. Delboeuf's formulation not only turns the proverb upside down but provides a way of understanding how polarizing controversies and schools of psychotherapy develop in psychiatry. Delboeuf has, however, received little attention in the anglophone world. He has a small place as a footnote to the history of psychoanalysis. Freud quoted one of Delboeuf's dreams at length to demonstrate how forgotten memories influence the creation of dreams and introduced the interpretation of his own dreams by quoting Delboeuf's modest statement that, “Every psychologist is obliged to admit even his weaknesses if he believes that doing so will throw light on some obscure problem" [Freud, 1900/1961,105]. In France Jacqueline Carroy and Francois Duyckaerts have appreciated Delboeuf's broader significance [Carroy, 1991; Duyckaerts, 1992]. Following up on their work, this paper uses detailed published accounts of Delboeuf’s investigations of patients at the Salpêtrière in Paris, his observations on the subjects of the stage hypnotist Donato and his own experiments in Liege Belgium to describe the observations that led him to his memorable insight into the social-psychology of polarizing controversies in psychiatry.Delboeuf achieved his insight during the polarizing confrontation over hypnosis that occurred in France during the 1880s between the illustrious Parisian neurologist, Jean Martin Charcot and Nancéén professor of medicine, Hippolyte Bernheim. Charcot argued that hypnosis was pathological and could be most readily, if not exclusively found, among hysterics. He had made his reputation as a neurologist by studying dramatic symptom complexes as prototypes of disease entities. Following this procedure in his study of hypnosis, he claimed that he had discovered a distinct three stage process consisting of lethargy, catalepsy and somnambulism, which could be elicited in hysterics. Bernheim , by contrast, saw nothing pathological about hypnosis, and no connection with hysteria. Bernheim came to hypnosis by observing the clinical practice of a country doctor A. A. Liébeault. Liébeault's aim was to heal his peasant patients of a wide variety of ailments, using hypnosis as a vehicle to suggest to them that they return to health. From his observations of Leibault Bernheim persuaded himself that hypnosis did not involve characteristic phenomenon, such as Charcot had found, but merely the imposition of the will of a hypnotist on a simple and passive subject [Ellenberger, 1970; Gauld, 1992].

Born in 1831 and Delboeuf received his doctorate in philosophy and letters in 1855. Before turning his attention to hypnosis, Delboeuf had an active and successful career in philosophy and psychology. He was a skeptic, a rationalist, and an experimental psychologist, with a profound commitment to the concept of freedom. Though skeptical about much of what he heard reported about hypnosis, he was not willing to dismiss the phenomena as mere imposture. As a rationalist he was determined to avoid being seduced by the 'mysteries' of hypnosis and to connect the explanation somnambulistic phenomena to the realm of psychological phenomena already analyzed by scientists [Delboeuf, 1887, 113]. In 1869, for example, he anonymously wrote articles offering naturalistic explanations for the regularly occurring stigmata of the would-be saint Louise Lateau. He even proposed an experiment to test the regularity of their occurrence. His commitment to freedom was such that in 1882, in the midst of the rising tide of positivism, he published an extended argument for the role of freedom, not only in human affairs, but also in the whole material world [Duyckaerts, 1992, 11-13].

When he finally turned his attention to hypnosis, during the last ten years of his life, these philosophic commitments colored his approach and influenced his conclusions. His approach was not that of a neuroscientist, seeking to establish new disease prototypes, or that of a medical doctor attempting to treat patients. As a philosopher with a deep commitment to freedom, he was reluctant to see hypnotic phenomena as either the result of disease, like Charcot, or as the result of mental passivity, as did Bernheim. As a rationalist he was determined to find simple explanations for his observations, As an experimental psychologist he was prepared to test these explanations by constructing experiments designed to prove them false. What is particularly intruiging for the historian of psychiatry is that Delboeuf's skeptical, rationalist, libertarian, and experimental outlook led him not only to a reconsideration of the phenomenon of hypnosis but to a reconsideration of the history of hypnosis itself. His first introduction to animal magnetism, as it was still known, was in college. Reading about a miraculous cure he turned to the library to see what he could read on the subject. By luck he came upon Alexandre Bertrand's Treatise on Somnambulism, written in the 1820s [Delboeuf, 1886a, 441]. Bertrand is well known as a skeptic about the 'fluidist' explanations, who , rather than dismissing the observed phenomena out of hand, sought other explanations. Delboeuf was to adopt a very similar orientation towards the hypnotic phenomena he later observed. Bertrand is less well known for his insightful social-psychological analysis of the controversies swirling around in the 1820s. Bertrand regarded those who saw themselves as possessed by demons and those who felt infused with magnetic fluid as equally unreliable witnesses of what was actually influencing them. He saw the phenomena displayed by these very different subjects as originating in the imagination of a subject. Her magnetizer or exorcist was so impressed by this that he later unconsciously molded other subjects to resemble her [Bertrand, 1823]. Without directly citing Bertrand, Delboeuf was later to offer a very similar analysis of the controversies of the 1880s. Bertrand's influence, however, undoubtedly guided Delboeuf's own experiments and helped him reach his conclusions as rapidly as he did. Delboeuf's direct involvement in hypnosis began in December 1885, when he visited Charcot's clinic in Paris. He had dabbled with hypnosis previously, but lore about its dangers and the stigma attached to its practitioners had always limited how far he went. In Paris he had strong philosophical reasons to challenge one of Charcot's fundamental findings. Delboeuf was concerned by the observation that, on waking, somnambulists could not remember what had occurred during 'sleep'. This troubled him because he had a metaphysical commitment to the idea that nothing, not even a memory, is permanently lost from the universe. Because he regarded personal memory as defining the self, which was the basis of personal identity, the failure to remember what occurred during hypnotic sleep also created the paradox of a person with two identities.At the start of his investigations Delboeuf accepted the commonly held nineteenth century assumptions that hypnosis was a form of sleep and that somnambulism was a form of dreaming. Based on these assumptions was sure that there must be conditions which would allow for remembering what occurred during somnambulism just as there were conditions that allowed for remembering dreams. After Charcot's students demonstrated that subjects did forget what they had done after being awoken from a somnambulistic state, Delboeuf created an experiment in which subjects were woken in the midst of putting out an imaginary fire. As he predicted, they remembered the fire as if it were a dream.As a newcomer to hypnosis Delboeuf viewed Charcot's demonstrations with respect. Nonetheless a number of observations aroused his skepticism. He thought that pictures of ecstatic saints lining the waiting room offered suggestions to patients on how to behave when hypnotized. Charcot's first patient greeted him with such familiarity that Delboeuf thought that she resembled an experimental subject more than a sick person [Delboeuf, 1886, 123]. As he watched Charcot's demonstration of catalepsy, one of the three characteristic stages of hypnosis, Delboeuf recalled that stage hypnotists had demonstrated the same phenomena at least forty years earlier [Delboeuf, Oct 1886, 125]. It was important to Delboeuf's perspective on hypnosis that he never made a distinction between hypnotic phenomena created by stage hypnotists and those observed by doctors. Indeed he seems to have identified more with the stage hypnotists than with the doctors. Even before going to Paris to observe Charcot, Delboeuf had published an anonymous defense of the stage hypnotist Donato, who had been dismissed as a charlatan by “les Parisiens” . Delboeuf saw the medical critique of stage hypnotists as largely turf protection and efforts to legally curtail the activities of men like Donato as an unwarranted and even dangerous restriction of human freedom. His familiarity with the work of these 'charlatans' was an important source of his understanding of the social-psychology of healing movements.After observing Charcot's demonstrations, Delboeuf was inclined to agree with Bernheim that such phenomena were the result of unconsciously suggestive maneuvers [Delboeuf,Oct 1886, 125]. His conclusions were not, however altogether in accord with Bernheim's, revealing the influence of Delboeuf's convictions about human freedom. Delboeuf concluded that what he had observed was due, not just to unconsciously suggestive maneuvers on the part of the hypnotist, but to an excessive willingness to accommodate [un excèss de complaisance] on the part of their subjects. "They could speak,' he insisted, for example, 'but they felt a duty to be quiet' [Delboeuf, Oct 1886, 147]. After leaving Paris, Delboeuf did not go directly to Nancy to observe Bernheim but returned home to Liege to try to reproduce Charcot's results for himself. He initially accepted Charcot's view that hypnosis was easier to induce in hysterical patients, but achieved only mixed results with such patients. Remembering Bernheim's claim that hypnosis were easier to produce in healthy, but simple subjects, Delboeuf began a series of experiments using two sisters who were his servants, without apparent concern about the influence of his role as master on his servants as subjects. Perhaps this worked because Delboeuf conducted his hypnotic sessions like a philosophy professor teaching a new student, at times speaking of giving his subjects 'a little lesson in psychology' [Delboeuf, May, 1886,455]. If his authority facilitated their learning, so much the better. When his experiments with the younger sister, M, were disappointing, Delboeuf decided to try to hypnotize the older sister, J., although he thought she would give him more trouble as a subject, because she was more intelligent than her sister. Contrary to these expectations, she rapidly entered a state of somnambulism and he was able get her to demonstrate a wide range of the phenomena he had observed in Paris. Delboeuf’s interpretation of J…’s rapid progress is remarkable for its contrast with with the the interpretations that both the Salpêtrière and the Nancy schools would have given to such performances. To Charcot and his followers J… would have to have been a hysteric. To Bernheim and his followers she would have been considered merely suggestible. In either case the power would lie in the hands of the hypnotist, while the subject would be either sick or extremely passive. For Delboeuf their roles were reversed. First, he marveled at her “intelligence,” self-consciously emphasizing it was her intelligence that allowed her to learn just what he wanted her to do so quickly and completely that a spectator could not discern just how he communicated his wishes to her. Second, he modestly noted that if his psychological studies had not put him on guard, he could have been fooled into believing that he had influenced her by his thought or will.His realization that his servant was smart enough to fool him, and that he was potentially gullible enough to be fooled into believing that he had power over her, opened the door to his realization that this dynamic could well have been working between largely female subjects and largely male hypnotists throughout the nineteenth century. This must have been, he added, how many magnetizers, honestly, came to believe in the power of their will [Delboeuf, 1886b, 153-4]. While Delboeuf was conducting his experiments with J..., he was invited to observe the work of an amateur magnetizer with a group of teen age boys, all of whom behaved in the same manner when hypnotized. Because of his familiarity with the stage hypnotist Donato, Delboeuf immediately realized that these subjects must have ‘passed through Donato's hands'. As Delboeuf knew, when Donato arrived in a new city, he recruited a cadre of subjects, usually of adolescent boys, who he trained in his method, or as Delboeuf put it, 'poured into his mold'. During public performances Donato called upon these subjects to do things that provoked astonishment and laughter in the audience. It was a group of these boys that the magnetizer had unwittingly discovered, and had made no effort to reshape. Because Delboeuf did not make the standard distinction between hypnosis as used in science and in entertainment, it appeared obvious that the type of subject that Donato created for his commercial purposes was a third type of hypnotic subject along with those “discovered” at the Salpêtrière and at Nancy. Donato’s boys had volunteered to be hypnotic subjects and might be seen as motivated to produce the best possible performance. Indeed, he added, he could put his subject J… into a forth category. Expanding the number of categories of hypnotic subjects by accepting the legitimacy of his own subject J… as well as Donato’s subjects on the same footing as those of both Charcot and Bernheim had important implications for his thinking. His conclusion from this insight is worth quoting:…if the subjects from Salpêtrière and those from Nancy present such remarkable differences, they have probably come from a certain type of training in part intentional, in part unconscious, in part accidental. The hypnotists would have been …inspired by the first results that they obtained and would have endeavored to obtain them subsequently, believing that they were essential and characteristic; the subjects, so influenced and almost guided, would have in their turn be used as models by newcomers who saw them or who heard them talked about; there would be, in this way, instituted a latent teaching supported by different traditions according to the milieux, and so would have given rise to types of schools in conflict today. Delboeuf's conclusion relates not only to the schools in conflict in his day but also to the schools in conflict in our day. More is at stake, however, than an original subject persuading her therapist, hypnotist, magnetizer or exorcist of the genuineness of her performance and he then training future subjects and students in his school. The first subject, her handler as well as future subjects and handlers must be prepared to accept a particular interpretation of the observed phenomena. In one period, demons have explained things for some. In other periods magnetic fluids, messages from the dead and more recently alters. Polarization occurs between those who are prepared and trained to see and believe and those who are not. The process that Delboeuf, and Bertrand before him, described helps explain how such polarizing conflicts develop and perhaps assures that they will continue to recur. Not satisfied with having established this typology of hypnotic subjects, Delboeuf, the experimentalist, also attempted to show that he could transform one type into another. Using imitation, he decided to produce hypnotic subjects in the same mold. First, he had M., who did nothing more than 'sleep', when he hypnotized her, watch J… demonstrate lethargy and catalepsy. As predicted M… was now able to enter these states, something she previously could not do. In a second experiment he had two of Donato’s subjects, who had their own type of hypnotic performance, watch J. and M. In a short time Delboeuf was able to get Donato's subjects to imitate J. and M. point for point. Not only was Delboeuf able to get these subjects to change type, but once they did so they continued to display the new set of hypnotic behaviors. The stability of this learned behavior as well as the failure to observe the learning, Delboeuf argued, created the illusion that scientists like Charcot were discovering naturally occurring phenomena. Having recognized how types of subjects are created and modified, as well as how hypnotists deceive themselves into overestimating their power, Delboeuf was in a position to critique the very assumptions with which he had begun his investigations, namely that hypnosis was a form of sleep. Delboeuf's attitude toward his subjects and his relationships with his subjects were already quite different from either those of Charcot or Bernheim. This led to different perceptions of what was going on during hypnosis. On the question of what, if anything was on subjects’ minds while they were in a state of hypnotic sleep it was easy to assume that nothing was on their minds. Indeed when asked they usually said that they were thinking of nothing. Delboeuf, however, noticed that J… was hardly indifferent to sounds around her. When asked, for example, to wake when the clock struck a particular time, she never failed to do so. For Delboeuf this was clear evidence of mental activity [Delboeuf, 1886b, 155]. With another subject S., who was unusual for the time in that she volunteered to be a subject, Delboeuf, who no longer believed subjects had to forget their somnambulistic state, could simply ask what was on her mind. In a series of experiments where he forbid her from doing things such as writing the number “7”, she complied but became sad. When he asked her why she was so sad she replied, " I cannot do what I want. M. Delboeuf had forbidden me to write ‘7’. It is in spite of myself. I am sad because of the uselessness of the efforts that I make.” Delboeuf found S.’s belief that she was not free and her revolt against the constraints he had imposed on her confirmed his view that subjects are not simply clay in the hands of their hypnotizers. [ Magnétisme Animal 18-19] Delboeuf began his investigations persuaded that hypnosis was a form of sleep and somnambulism was a form of dreaming. These comparisons were essential to his efforts to refute the philosophically provocative assertion that subjects cannot remember their somnambulistic state on waking. Initially, while visiting Charcot in Paris, he attempted to create conditions that allow for remembering. Later he concluded that the whole question of remembering or forgetting was a matter of the type of somnambulist one created. He began to see the idea of hypnosis as a form of sleep as useful metaphor for creating certain phenomena. Making use of this metaphor depended, in turn, on the subject's willingness to accept the hypnotist's suggestion that she was 'asleep.' With this insight Delboeuf went on to claim, somewhat tongue in cheek, that there was no such thing as hypnosis [Delboeuf, 1891-2]. In the last paper that he wrote before his death in 1896, at the age of 65, he more seriously suggested that the term hypnosis no longer be used because it created the misimpression that sleep was involved in the process. Instead he suggested that the term hypnosis be replaced by the term 'psychotherapy', or better yet 'psychodynamics' [Delboeuf, 1892-3]. With this suggestion Delboeuf completed his liberation from the mold of nineteenth century ideas about hypnosis and opened the way to twentieth century ideas about the collaboration of patient and therapist. Perhaps it is not surprising that Freud found so much to learn from the modest Belgian philosopher, who believed in freedom.

Edward M. Brown

As presented to the European Association for the History of Psychiatry, Madrid, Spain, September 2002.